Health Services Research Commons^™

Communicating To Beneficiaries About Medicare+Choice: Opportunities And Pitfalls, Nora Super

National Health Policy Forum

This issue brief explores the opportunities and potential pitfalls in communicating to beneficiaries about Medicare+Choice. This issue brief also looks at the difficulties inherent in communicating complex information to a diverse group of older individuals as well as at communications and programmatic challenges related to information overload, marketing concerns, lack of uniform standards, lack of infrastructure, and the vulnerability of various subpopulations.

Medicare Coverage And Technology Diffusion: Past, Present, And Future, Robin J. Strongin

National Health Policy Forum

This issue brief provides an overview of the Medicare coverage process. Coverage involves deciding whether or not to pay for a particular service or product. This brief examines Medicare's coverage determination process, which includes technology assessment, payment determination, and the demand for evidence. Options for improving the coverage determination process are reviewed.

Erisa Health Plan Denials: Exploring Models For External Review, Karl Polzer

National Health Policy Forum

This paper outlines the current process under the Employee Retirement Income and Security Act (ERISA) by which plan participants can appeal a claim denial as well as changes to the claims procedure requirements being considered by the Department of Labor. It describes state legislative activity in this area and summarizes research describing practices currently in place among managed health care organization. The paper also describes two existing models for external review of managed care plan decisions, one used by the Medicare program and another by the state of Florida.

Site Visit To New Jersey — State And County Experiences With Welfare Reform And Access To Health Care, Michael Anzick, Richard Hegner

National Health Policy Forum

This site visit was the second in a series to examine what is occurring at the state and local level with respect to welfare reform, Medicaid, public health, and safety net and other supportive services. During this visit, policymaker discovered how state officials, directors, and front-line staff at urban and suburban county welfare offices are working with clients to move them off the welfare rolls into jobs and providing the support services necessary for job retention; heard from clients about how programmatic changes are affecting them and their families; learned how the role of safety net health care and temporary …

Dual Diagnoses: The Challenge Of Serving People With Concurrent Mental Illness And Substance Abuse Problems, Richard Hegner

National Health Policy Forum

This paper describes the prevalence of comorbid mental disorders in the population and discusses what is known about causality and relapse. The relationship between dual diagnosis and homelessness and crime is also discussed. The paper also explores options for improving treatment among the dually diagnosed.

Increasing The Federal Cigarette Tax: A Means Of Reducing Consumption?, Lauren Tran, Richard Hegner

National Health Policy Forum

This issue brief probes the economic issues associated with tobacco and cigarettes. It examines the possible effectiveness of a tax increase as a strategy to reduce cigarette consumption, especially among young people, and the likely ramifications of a tax increase for the tobacco industry.

Restructuring The Va Health Care System: Safety Net, Training, And Other Considerations, Barbara Skydell

National Health Policy Forum

This paper provides an historical overview of the modern Veterans Administration (VA) healthcare system and describes the multiple missions of the VA — patient care, health professions education, research, and medical preparedness. The VA's reform plan, which addresses issues related to decentralization, management and oversight, resource allocation, eligibility reform, and primary/ambulatory care, is also described and discussed. Challenges facing the VA as it transitions to a greater focus on prevention, primary care, and care management are also addressed.

The Federal Employees Health Benefits Program: What Lessons Can It Offer Policymakers?, Karl Polzer

National Health Policy Forum

This paper provides an historical overview of the Federal Employees Health Benefits (FEHB) program and its marketplace dynamics. It also reviews key program features and issues, including payments to health plans, strategies used to mitigate the opportunities for risk selection, and costs.

Site Visit To Philadelphia — Providing Community-Based Primary Care: Nursing Centers, Chcs, And Other Initiatives, Karen Matherlee

National Health Policy Forum

This site visit provided federal congressional and agency health staff opportunities to visit facilities and engage in discussions on essential community health services. Focused on community-based primary care in a managed care environment, it featured delivery and financing concerns relating to nursing centers, community health centers, public-mission hospitals, and homeless services. In examining the impact of managed care in a rapidly changing health marketplace, it explored the implementation of the Medicaid HealthChoices program in the city as well as access to and delivery of care to persons with neither public nor private insurance. It also looked at the role of …

Site Visit To Northern California — Risk, Accountability, And Staying Power In Next-Generation Managed Care, Lisa Sprague, Sandra Foote

National Health Policy Forum

This three-day site visit looked at private health insurance and delivery of care in a market notable for high managed care penetration, relatively low premium costs, and sophisticated provider groups. Federal congressional and regulatory staff heard from health insurance purchasers (both public and private), health plans, hospital systems, and physician groups about the changing relationships and accountabilities in this market and the ways various organizations were positioning themselves to survive the turmoil and emerge the stronger for it. Participants also heard from two county health programs about how competition and realignment in the private market were impacting safety-net services for …

Health Care Quality: From Data To Accountability, Mary Darby

National Health Policy Forum

This paper discussed the evolution of quality measurement and reporting activities as well as efforts to develop accountability for delivering high-quality care. It examined (a) initiatives in the professional arena, such as accreditation and performance measurement by independent accrediting bodies; (b) activities of market proponents, who have preferred to concentrate on making data available to purchasers and consumers that would enable them to choose high- quality plans and providers; and (c) attempts by the public sector to secure quality through regulation and oversight. An exploration of the successes, limitations, overlaps, and gaps in quality assurance initiatives, the paper was published …

Condom Availability In New York City Public High Schools: Relationships To Condom Use And Sexual Behavior, Sally Guttmacher, Lisa D. Lieberman, David Ward, Nick Freudenberg, Alice Radosh, Don Des Jarlais

Department of Public Health Scholarship and Creative Works

OBJECTIVES: This study examines the impact of the condom availability program in New York City public high schools by comparing rates of sexual activity and condom use for New York students and similar students in Chicago. METHODS: A total of 7119 students from 12 randomly selected New York schools and 5738 students from 10 Chicago schools participated in a cross-sectional survey. RESULTS: New York students, compared with Chicago students, reported equal rates of sexual activity but higher rates of condom use at last intercourse (odds ratio [OR] = 1.36). For higher-risk students (those with three or more sexual partners in …

Small Group Market Health Insurance Purchasing Cooperatives Revisited, Karl Polzer

National Health Policy Forum

As Congress was in the final stages of considering the Clinton administration's proposal for comprehensive health reform and various derivatives of it, this Forum session examined the progress of several purchasing cooperatives in helping employees of small firms find affordable insurance coverage. The first half of the meeting focused on California's purchasing alliance, especially its impact on prices in the small-group insurance market. Varying models of cooperatives (or alliances) being set up in Florida, Iowa, and Kentucky also were discussed, with special attention being paid to their potential for addressing fundamental problems such as rising costs and access to insurance.

Federal Support For Medical Education: Framing The Issues For The Systems Reform Debate, Karen Matherlee

National Health Policy Forum

Designed primarily for federal legislative and regulatory health staff involved in systems reform efforts, the session provided a primer on current medical education policies (with emphasis on federal strategies) and a prospectus on policies to change them.

Barren River District Health Department Health Education/Risk Reduction Demonstration Projects, Rebecca Bruce

Masters Theses & Specialist Projects

In July 1980, the Barren River District Health Department (BRDHD), serving eight counties (combined population approximately 204,000) in Southcentral Kentucky, was selected as a demonstration site under the auspices of the federal Health Education Risk Reduction (HERR) Program. With continued HERR funding for eight years, the BRDHD developed several successful health promotion projects. Major components of these projects include: 1) community health promotion, which serves to identify high -risk groups in the community and provide them with health education-health promotion services, 2) school health education which included the development of a preschool health education curriculum, 3) teacher education workshop, which …

Population-Based Measurement Of Hospital Use In Maine Areas, 1976, David Soule

Maine Collection

Population-Based Measurement of Hospital Use in Maine Areas, 1976

Prepared by: David Soule, Data Analyst, Maine Health Data Service, Project Director - Maine Hospital Statistics Analysis Project, December, 1979.

With complementary funding from: Cooperative Health Statistics System, National Center for Health Statistics, Contract No. (HRA) 230-76-0298.

Bureau of Health Planning and Development, Maine Department of Human Services.

Maine Health Data Service. Blue Cross and Blue Shield of Maine.

Contents; Acknowledgements / Introduction / Data Sources and Definitions / Findings / References / Appendix Tables